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WHO and partners step up measures to ensure the safety of blood
Between 5% and 10% of human immunodeficiency virus (HIV) infections worldwide have been attributed to tainted blood and blood products. Many blood recipients are also infected with hepatitis viruses, Chagas’ disease and other agents transmitted by blood. Although errors affecting blood safety can occur at any point in the transfusion chain, one of the major causes of wrong blood transfusion is due to errors at the bedside.
To address the problem and ensure safer bedside transfusion practices both in the developing and the developed world, WHO and its partners in the Global Collaboration for Blood Safety (GCBS) coalition recently launched a package of comprehensive measures for implementation by countries with the support of partners in the GCBS. These measures include:
• Developing a guidance document on monitoring and improving transfusion recipient safety (particularly wrong blood transfusions) through haemovigilance systems;
• Sensitizing policy-makers on the need to implement a haemovigilance system and establish hospital transfusion committees in all hospitals practising transfusions and advocating that systems of monitoring and improving transfusion safety should be part of an overall quality system for the entire transfusion chain;
• Incorporating blood safety into patient safety initiatives at national level and supporting WHO’s Patient Safety Initiative in advocating haemovigilance optimally as an integral part of hospital quality system.
Even in countries where health risks due to blood transfusion can be shown to be minimal, many remain anxious about the small residual risks of known transfusion-transmitted agents. It is also clear that current technology will lead to the discovery of more blood-borne transmissible agents. Other potential errors in transfusion, such as misadministration or bacterial contamination, also constitute a substantial clinical risk.
New blood safety technologies are constantly becoming available and are actively marketed to professionals and, indirectly, to the public. In developed countries, many of these additional safety measures can offer only marginal gains at very high cost. Nevertheless, because there is such pressure to take any precautionary action that could reduce the risks of blood transfusion, the appearance of a new safety technology on the market poses a dilemma for the policy-maker faced with competing priorities. In contrast, patients in many developing countries are at high risk due to transfusion of unsafe, tainted blood. Globally, blood transfusion is usually over-prescribed, both in the developed and the developing world. Irrational use of blood, unnecessary transfusions and unsafe, poor transfusion practices at patient bedsides further compromise the safety and availability of blood and blood products. In some countries, transfusion-associated infections contribute substantially to the overall burden of infection in the population. International travel and the movement of blood, especially of plasma and plasma derivatives, makes this a global as well as a national public health concern.
The GCBS was established following a decision to select blood transfusion safety as a priority strategy for the Paris AIDS Summit in 1994. There was unanimous agreement on the need for global collaboration to improve blood safety by building on knowledge, utilizing existing expertise, promoting dialogue and suggesting realistic, effective and practical mechanisms to improve blood and blood product safety. In May 1995, the Forty-eighth World Health Assembly adopted resolution WHA48.27, supporting the principles of the GCBS.
A WHO-hosted network, the Global Collaboration for Blood Safety is a global voluntary international partnership of stakeholders working to achieve global blood safety. About 60 internationally recognized governmental and nongovernmental organizations, institutions, associations, agencies and experts from developing and developed countries, and umbrella industrial organizations. The GCBS provides a platform for sharing expertise, identifying problems, seeking solutions and working towards the common goal of global blood safety.
The primary goal of the GCBS is to promote and strengthen international collaboration on safety of blood and blood products and transfusion practices, with a view to encourage and facilitate information exchange, promote standards for good manufacturing practices for blood and related products for transfusion, and foster the establishment and implementation of cooperative partnerships to ensure donor and recipient safety in all countries.
Since 2000, the key GCBS collaborative partners have met annually in a general meeting. The seventh general meeting of the GCBS took place on 14–17 November 2006 in Cairo, Egypt. It was organized jointly by WHO headquarters and Regional Office for the Eastern Mediterranean. There were 54 participants from 28 countries. The main objectives of the meeting were to review global efforts, progress and collaborative initiatives in blood safety, identify challenges and propose solutions in optimizing the transfusion chain, with regard to selecting safe donors, providing required products to meet patient needs, and transfusion practices at the bedside and develop recommendations to GCBS participants to implement further actions for blood safety.
Is pandemic influenza looming?
The World Health Organization today ended a three-day meeting of international experts focusing on communication during a human influenza pandemic. The Second International Meeting on Pandemic Influenza Communications was attended by over 100 representatives from over 50 countries, other UN agencies and other organizations. It was opened jointly by His Excellency Dr Hatem El-Gabaly, Minister of Health and Population of Egypt, and Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean.
The meeting was held in Cairo because of the demonstrated commitment of the Government of Egypt to providing timely and transparent information to the people of Egypt, and the world, about human cases of avian influenza. “Egypt has set the standard for transparency,” said Dick Thompson, team leader for WHO’s Outbreak and Pandemic Communication group, and an organizer of the meeting. “During a pandemic, vaccines will be limited and late, and antivirals will be in short supply everywhere. The strongest public health tool available will be official health advice that is trusted. Although no one knows when a pandemic will start, we do know that preparedness will reduce the harm from a pandemic. The work that Egypt is doing now is building a reservoir of trust which may be needed during the pandemic.”
Deliberations focused on social mobilization, messages before and after a pandemic, and networking.
The role of social mobilization as an integral component of effective pandemic influenza preparedness and response was widely endorsed by participants. It was agreed that planning for, and adopting appropriate behaviours before, during and after a human influenza pandemic can help reduce illness, death and socioeconomic disruption. In order to enable countries to develop social mobilization strategies, participants agreed to review existing social mobilization assessment tools which countries could then use to conduct gaps analyses. Once completed, the analyses will help determine what resources are required to develop and implement social mobilization campaigns at a country and community level. A framework for social mobilization which will include guiding principles, check lists, and specific guidance for appropriate behavioural interventions will be developed within the next year.
Messaging and nomenclature were two critical issues discussed during a special workshop session. These issues will be crucial for addressing the initial confusion that is likely to arise in a global emergency such as a pandemic. Responding with consistent messaging will help public health officials deal with uncertainty, avoid confusion and maintain public confidence at a critical time. The meeting also considered the need for standardization of avian and pandemic influenza terminology and descriptions.
Key recommendations from the meeting included formulating a priority list of topics for which messages could be developed and developing checklists to assist countries with planning communication activities. The meeting also endorsed a glossary of avian and pandemic influenza terms. The participants recognized that although a considerable amount of progress was made at the meeting, much more detailed work will be required in order to achieve the objectives of the meeting, among which were to assist countries with their preparation. To this end, the meeting recommended the formation of a messaging advisory group to follow up activities and carry forward the recommendations. Mrs Denise Carter Taylor, who chaired the workshop session, said, “The messaging and nomenclature workshop and the recommendations which emerged were seen as a critical input for helping countries to ensure that communication remains an integral component of human influenza and avian influenza preparedness planning.”
World Tuberculosis Day 2007
With the approach of World Tuberculosis Day, held on 24 March 2007, many challenges remain for tuberculosis control at both the global and regional levels. Among all communicable diseases, tuberculosis is still the number one killer of adults. It is responsible for 2 million deaths in the world every year, 111 000 of which occur in the Eastern Mediterranean Region, where approximately 560 000 cases of active tuberculosis infection occur yearly. These deaths could be prevented entirely by applying measures that are both available and affordable.
Early detection of cases is a major problem in the Region, where the case detection rate stands at only 44%, well short of the 70% global target declared in 2005. Apart from Bahrain and the Libyan Arab Jamahiriya, none of the countries of the Region have been able to reach this target. This is inconsistent with the success in reaching the global target for treatment success, namely successful treatment of 85% of detected cases, which was achieved by Lebanon, Morocco, Oman, Somalia and Tunisia, and which all other countries of the Region are close to achieving, with an average of 83%.
“TB anywhere is TB everywhere”. This attention-grabbing message was chosen by WHO as the theme for this year’s World Tuberculosis Day. It is meant to ring alarm bells and serve as a reminder of several important facts. It also aims at correcting common misconceptions about tuberculosis.
Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean, states that “Tuberculosis is not a disease of the past. Tuberculosis is not only the poor people’s problem. Finding and treating tuberculosis patients is not solely the responsibilities of ministries of health. If tuberculosis is anywhere, then tuberculosis can be found everywhere. The national tuberculosis programmes alone cannot possibly detect and provide care for all tuberculosis cases, even if they double or triple their efforts. Only through a joint, effective and strong collaborative partnership will we have the power to reach a wider audience, to overcome the challenges facing us and eventually put an end to the suffering from tuberculosis in the Region”.
About 95% of the tuberculosis burden is concentrated in nine countries of the Region: Afghanistan, Egypt, Iraq, Islamic Republic of Iran, Morocco, Pakistan, Somalia, Sudan and Yemen. In addition, Djibouti has one of the highest tuberculosis incidence rates in the world.
Challenges facing tuberculosis control programmes are intensified by the worsening HIV/AIDS epidemic and the ubiquity of multidrug-resistant tuberculosis, possibly in the form of extensively drug-resistant tuberculosis, which is incurable. Surveys conducted in countries such as Egypt, Jordan, Lebanon, Oman, Syrian Arab Republic and Yemen have found drug-resistant tuberculosis among different segments of the population in all places, which contradicts the notion that tuberculosis affects only the poor.
In addition to being an extremely serious public health problem, tuberculosis is also an important developmental problem. The disease affects young adults, as 70% to 80% of cases occur among the age group of 15 to 54 years. This is the most socially and economically productive age group in society, and patients are usually the breadwinners in their families. Suffering from tuberculosis means a long duration of illness, often for a period of several years, and a long period of treatment (at least 6 to 8 months). Illness obviously affects the patients’ social and economic productivity, and thus their income. Moreover, they may experience catastrophic health expenditure.
This is happening despite the availability of tuberculosis care throughout the Region under the DOTS (directly observed treatments, short-course) strategy, implemented in countries of the Region for the past ten years, and despite the fact that about two million cases were detected and successfully treated between 1996 and 2005.
The DOTS strategy currently covers 97% of population in the Region. WHO is working on expanding tuberculosis care through adaptation of the new Stop TB strategy, which is a comprehensive set of tuberculosis care activities based on DOTS. The strategy consists of six components: pursuing expansion of high-quality DOTS activities; addressing multidrug-resistant tuberculosis, co-infection with HIV and other challenges; contributing to health system strengthening; engaging all care providers; empowering people with tuberculosis, and communities; and enabling and promoting research.
Other strategic targets have been set by WHO, in addition to 70% case detection and 85% treatment success by the year 2010. The most important of these targets are to reduce the regional burden of tuberculosis disease by 50% relative to 1990 levels by the year 2015, and to reduce the regional incidence of tuberculosis disease to less than one per million population by the year 2050.
Within the framework of World Tuberculosis Day observances, WHO will take part in the Fifth Annual Scientific Meeting of the Saudi Society of Chest Diseases, which will be held concurrently with the Twenty-sixth Regional Meeting of the International Union Against Tuberculosis and Lung Disease, and the Forum on New Developments in Respiratory Care, from 20 to 22 March 2007, in Riyadh, Saudi Arabia.
WHO’s activities in support of tuberculosis control in the Region will not be limited to celebrating World Tuberculosis Day, but will extend throughout the entire year. The main objective is to detect more tuberculosis cases and provide appropriate treatment for them, which will lead to achievement of the global targets.
